In This Big Pharma Simulator, Profits Matter More Than Patients

Ever fancied running your own corrupt medical drugs business? This is the game for you.

is a management simulation game that, to quote its UK-based creator Tim Wicksteed, explores "the strange ethical dilemmas that occur when you bring together the goal of curing the sick with the burden of running a profitable business."

Unlike many an artwork with a social or political message, however, it isn't an exercise in pointing fingers. Rather, Big Pharma shows how dangerously easy and routine it can become to disregard the human fallout of a decision while operating in an abstract world of market trends and logistical planning.

The game's world isn't just abstract—it's downright cosy. Now available in beta to pre-ordering players, with a Steam release to follow, Big Pharma recalls the cartoon look and handling of the Bullfrog-developed classic Theme Hospital. Most of it takes place on your production floor, a cheery expanse of checkerboard floating in a clinical grey void, where you buy and click together chunky, pleasingly animated machines that turn raw materials into products such as pills and creams.

Screenshot: Big Pharma

Each ingredient must be discovered by hiring explorers to scour the unseen world beyond your factory, then imported for a fee. All of them have a number of possible effects, good and bad. To unlock or cancel out these traits, you need to feed the ingredient through various devices that alter its concentration, or combine it with another substance, before ferrying the results to the export hopper. In theory, of course, you'll want to ship the most effective cures you can while ironing out negative symptoms such as constipation. But in practice, this may not make sense economically.

"You can deliberately hold off producing your tuberculosis remedy until it infects half of Africa, in order to maximise your profits."

Each component in a production line takes a small chunk out of your earnings each and every time it's used, so the more elaborate the purification and enhancement process you set in motion, the smaller your net profit. A cheap 'n' dodgy migraine remedy that causes hypertension and diarrhea may prove more lucrative, overall, than an expensive miracle cure that obliges you to fill up your real estate with ionisers and condensors.

More sinisterly yet, Big Pharma also generates an evolving worldwide market simulation that takes into account the global distribution of diseases versus the distribution of income. Thus, in addition to letting the player cut corners with each drug, it allows you to callously ignore regions where the need for treatment is greatest but wallets are light.

"A cure for hair loss is a relatively small market but is highly valuable to the rich Westerners who demand it," Wicksteed told me by email. "Whereas an antimalarial drug is in very high demand but can't sustain such a high price, because most of the demand is coming from people living in poorer countries."

There's the projected infection rate of each disease to consider, too. "You can deliberately hold off producing your tuberculosis remedy until it infects half of Africa, in order to maximise your profits."

Wicksteed became interested in such ethical breaches after reading Dr Ben Goldacre's acclaimed 2012 book , which examines how companies such as GlaxoSmithKline have about the usefulness and drawbacks of their products. On balance, he feels that such failings are evidence of "systematic" problems rather than confined to a particular set of corporations.

"People are incentivised to make decisions for the good of the company or themselves to the detriment of patients," Wicksteed commented. "This is very human. It's something we've all encountered at work under the pressure to hit a deadline or get a certain result. The problem with this in the pharmaceutical industry is that it can lead to human suffering, or worse, death. It's because of this that I try to avoid overtly demonising the industry in the game, and prefer to simply place the player in a position of power and ask 'what would you do?'"

Not very encouragingly, Wicksteed has found that Big Pharma players "are very profit driven, and don't give a second's thought to sacrificing quality to make a few extra dollars per sale." This may, however, reflect a lack of in-game accountability systems to counter the siren wail of your company's bottom line—compromised or feeble remedies sell for less, but there's no blowblack from injured members of the public, and no threat of a legal challenge. "Something I'm looking at as development continues is adding an approval rating system which will allow for more permanent consequences to nefarious deeds, and hopefully give the player a greater sense of identity, of their role in the world—positive or otherwise," said Wicksteed.

Screenshot: Big Pharma

This parallels the ongoing struggle among medical practitioners to raise awareness of how drug companies make and market their products, working through a fog of legal checks and propaganda. Dr Goldacre has confessed to being "constantly staggered that this isn't taught in schools, explained on telly, and understood by all normally educated people, as the parts of the body or the plays of Shakespeare are."

While designed to be entertainment first and foremost, sims like Big Pharma might serve a couple of important purposes in this regard. On the one hand, they're a means of promoting the issue in itself. On the other, they allow us to model how a publicly listed corporation's activities could be tracked and regulated.

In the short term, reactions to the Big Pharma beta are cause for both hope and consternation about the pharmaceutical industry's future. "One pair of players who came and played the game at a show in London were determined to create a drug which caused nothing but 'anal leakage,'" Wicksteed recalled. "The nicest thing I've seen someone do is create a product which cures baldness, is a male contraceptive, combats liver disease, and vaccinates against cancer. They called it the 'Male Wonder Pill.'"

Modern Medicine is a series on Motherboard about how health care and medical technology can move forward so rapidly while still being stuck in the past. Follow along here.